BILL NUMBER: AB 1161	CHAPTERED  08/24/99

	CHAPTER   227
	FILED WITH SECRETARY OF STATE   AUGUST 24, 1999
	APPROVED BY GOVERNOR   AUGUST 23, 1999
	PASSED THE ASSEMBLY   AUGUST 16, 1999
	PASSED THE SENATE   JULY 15, 1999
	AMENDED IN SENATE   JUNE 15, 1999
	AMENDED IN ASSEMBLY   APRIL 5, 1999

INTRODUCED BY   Assembly Member Soto

                        FEBRUARY 25, 1999

   An act to amend Sections 14006.3 and 14006.4 of the Welfare and
Institutions Code, relating to health.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1161, Soto.  Medi-Cal:  nursing facilities.
   Existing law provides for the Medi-Cal program, administered by
the State Department of Health Services, under which qualified
low-income persons are provided with health care services.  Services
provided under the Medi-Cal program include skilled nursing and
intermediate care facility services provided by nursing facilities.
   Existing law requires the department and any nursing facility, at
the time of either application for Medi-Cal benefits or of the
assessment of the resources of a married couple when one spouse is
institutionalized, prior to admitting any person, to provide a clear
and simple statement, in writing, to the applicant or recipient, to
his or her spouse, and to his or her responsible relative, explaining
how Medi-Cal eligibility requirements affect their separate and
community property.
   This bill would no longer require this statement to be provided to
a responsible relative, but would require it to be provided to the
legal representative or agent, if any, of the applicant or recipient.
  It would also revise the statement to explain the resource and
income requirements of the Medi-Cal program including, but not
limited to, certain exempt resources, certain protections against
spousal impoverishment, and certain circumstances under which an
interest in a home may be transferred without affecting Medi-Cal
eligibility.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  It is the intent of the Legislature to update existing
law so that the State Department of Health Services and each nursing
facility are required to provide all incoming nursing facility
residents and their representatives with an accurate summary of the
law governing Medi-Cal reimbursement for nursing facility care.
  SEC. 2.  Section 14006.3 of the Welfare and Institutions Code is
amended to read:
   14006.3.  The department, at the time of application or the
assessment pursuant to Section 14006.6, and any nursing facility
enrolled as a provider in the Medi-Cal program, prior to admitting
any person, shall provide a clear and simple statement, in writing,
in a form and language specified by the department, to that person,
and that person's spouse, legal representative, or agent, if any,
that explains the resource and income requirements of the Medi-Cal
program including, but not limited to, certain exempt resources,
certain protections against spousal impoverishment, and certain
circumstances under which an interest in a home may be transferred
without affecting Medi-Cal eligibility.
  SEC. 3.  Section 14006.4 of the Welfare and Institutions Code is
amended to read:
   14006.4.  (a) The statement required by Sections 14006.2 and
14006.3 shall be in the following form:
      "NOTICE REGARDING STANDARDS FOR MEDI-CAL ELIGIBILITY

   If you or your spouse is in or is entering  a nursing facility,
read this important message!
   You or your spouse do not have to use all your resources, such as
savings, before Medi-Cal might help pay for all or some of the costs
of a nursing facility.
   You should be aware of the following to take advantage of these
provisions of the law:
      UNMARRIED RESIDENT

   An unmarried resident is financially eligible for Medi-Cal
benefits if he or she has less than (insert amount of individual's
resource allowance) in available resources.  A home is an exempt
resource and is not considered against the resource limit, as long as
the resident states on the Medi-Cal application that he or she
intends to return home.  Clothes, household furnishings, irrevocable
burial plans, burial plots, and an automobile are examples of other
exempt resources.
   If an unmarried resident is financially eligible for Medi-Cal
reimbursement, he or she is allowed to keep from his or her monthly
income a personal allowance of (insert amount of personal needs
allowance) plus the amount of health insurance premiums paid monthly.
  The remainder of the monthly income is paid to the nursing facility
as a monthly deductible called the "Medi-Cal share of cost."
      MARRIED RESIDENT

   If one spouse lives in a nursing facility, and the other spouse
does not live in a nursing facility, the Medi-Cal program will pay
some or all of the nursing facility costs as long as the couple
together does not have more than (insert amount of Community Spouse
Resource Allowance plus individual's resource allowance) in available
assets.  The couple's home will not be counted against this (insert
amount of Community Spouse Resource Allowance plus individual's
resource allowance), as long as one spouse or a dependent relative,
or both, lives in the home, or the spouse in the nursing facility
states on the Medi-Cal application that he or she intends to return
to the couple's home to live.
   If a spouse is eligible for Medi-Cal payment of nursing facility
costs, the spouse living at home is allowed to keep a monthly income
of at least his or her individual monthly income or (insert amount of
Minimum Monthly Maintenance Needs Allowance), whichever is greater.
Of the couple's remaining monthly income, the spouse in the nursing
facility is allowed to keep a personal allowance of (insert amount of
personal needs allowance) plus the amount of health insurance
premiums paid monthly.  The remaining money, if any, generally must
be paid to the nursing facility as the Medi-Cal share of cost.  The
Medi-Cal program will pay remaining nursing facility costs.
   Under certain circumstances, an at-home spouse can obtain an order
from an administrative law judge that will allow the at-home spouse
to retain additional resources or income.  Such an order can allow
the couple to retain more than (insert amount of Community Spouse
Resource Allowance plus individual's resource allowance) in available
resources, if the income that could be generated by the retained
resources would not cause the total monthly income available to the
at-home spouse to exceed (insert amount of Monthly Maintenance Needs
Allowance).  Such an order also can allow the at-home spouse to
retain more than (insert amount of Monthly Maintenance Needs
Allowance) in monthly income, if the extra income is necessary "due
to exceptional circumstances resulting in significant financial
duress."
   An at-home spouse also may obtain a court order to increase the
amount of income and resources that he or she is allowed to retain,
or to transfer property from the spouse in the nursing facility to
the at-home spouse.  You should contact a knowledgeable attorney for
further information regarding court orders.
   The paragraphs above do not apply if both spouses live in a
nursing facility and neither previously has been granted Medi-Cal
eligibility.  In this situation, the spouses may be able to hasten
Medi-Cal eligibility by entering into an agreement that divides their
community property.  The advice of a knowledgeable attorney should
be obtained prior to the signing of this type of agreement.
   Note:  For married couples, the resource limit ((insert amount of
Community Spouse Resource Allowance plus individual's resource
allowance) in (insert current year)) and income limit ((insert amount
of Minimum Monthly Maintenance Needs Allowance) in (insert current
year)) generally increase a slight amount on January 1 of every year.

      TRANSFER OF HOME FOR BOTH A MARRIED AND AN UNMARRIED RESIDENT

   A transfer of a property interest in a resident's home will not
cause ineligibility for Medi-Cal reimbursement if either of the
following conditions is met:
   (a) At the time of transfer, the recipient of the property
interest states in writing that the resident would have been allowed
to return to the home at the time of the transfer, if the resident's
medical condition allowed him or her to leave the nursing facility.
This provision shall only apply if the home has been considered an
exempt resource because of the resident's intent to return home.
   (b) The home is transferred to one of the following individuals:
   (1) The resident's spouse.
   (2) The resident's minor or disabled child.
   (3) A sibling of the resident who has an equity interest in the
home, and who resided in the resident's home for at least one year
immediately before the resident began living in institutions.
   (4) A son or daughter of the resident who resided in the resident'
s home at least two years before the resident began living in
institutions, and who provided care to the resident that permitted
the resident to remain at home longer.
   This is only a brief description of the Medi-Cal eligibility
rules, for more detailed information, you should call your county
welfare department.  You will probably want to consult with the local
branch of the state long-term care ombudsman, an attorney, or a
legal services program for seniors in your area.

   I have read the above notice and have received a copy.  Dated:
______                               Signature: _________"

   (b) The statement required by subdivision (a) shall be printed in
at least 10-point type, shall be clearly separate from any other
document or writing, and shall be signed by the person to be admitted
and that person's spouse, and legal representative, if any.
   (c) Any nursing facility that willfully fails to comply with this
section shall be subject to a class "B" citation, as defined by
Section 1424 of the Health and Safety Code.
   (d) The department may revise this statement as necessary to
maintain its consistency with state and federal law.
